ISSN 2039-4632 vol. 4, n. 1.2013

ISSN 2039-4632 vol. 4, n. 1.2013

an International Journal of Medical Sciences ISSN 2039-4632 Director and editor-in-chief Musiani Irio Medimond s.r.l. - Via G. Verdi 15/1, I-40065 Pianoro (Bologna) e-mail: info@medimond.com - www.medimond.com This journal was printed in July 2013 by EDITOGRAFICA s.r.l., www.editografica.com. 2013 - Medimond s.r.l., Via G. Verdi 15/1, I-40065 Pianoro Bologna. All rights reserved. Single photocopies of single articles may be made for personal use. Written permission from the publisher is required for all other photocopying. Subscriber may reproduce tables of contents or prepare list of articles including abstracts for internal circulation within their institutions. Permission of the publisher is required for all other derivative works, including compilations, translations, electronic store and use, and transmissions in any form or by any means.

Index Front page... I Neurotology & Equilibriometric From Pulec s Cervical Tinnitus to Levine s Somatic Tinnitus Alpini D.C., Cesarani A., Hahn A.... 1 Chronic Cerebrospinal Venous Insufficiency (CCSVI) IN Meniere Disease. Case or Cause? Alpini D.C., Bavera P.M., Hahn A., Mattei V.... 9 Diagnostic and rehabilitation of vestibular disorders with using of telemedicine tools Kelm M., Dabrowska A., Skarzynski P.H., Skarzynski H.... 17 Vestibular aspects in cochlear implant procedure Skarzynski P.H., Tacikowska G., Skarzynski H., Matusiak M., Sosna M., Pietrasik K.... 21 Cardiac Surgeons Mechanical bridging to recovery after heart transplantation Schmid C.... 25 Replacement of Ascending Aorta with Bentall DeBono Technique Vargas R., Perez R., Yeger A., Cuesto I., Cabo J.... 29 Intramyocardial Implantation of Stem Cells in Combination with CABG in AMI with Severe Ventricular Dysfunction. First Cases in Dominican Republic Vargas R., Benzo M., Grullón E., Cabo J.... 35 Clinical and echocardiographic results with a new three-dimensional tricuspid ring Arévalo Abascal A., González Santos J.M., Arnáiz García E., López Rodríguez J., Bueno Codoñer M., Dalmau Sorlí M.J.... 43 2013 by MEDIMOND III

IV ScienceMED, vol. 1, 5.2013, Bologna Preoperative Levosimendan Treatment in High Risk Surgical Patients with Ischemic Mitral Disease Ferreiro A., Garrido J.M., Muñoz R., Gajate L., Boi S., Martín M., Prada P., Redondo A., Miguelena J., Oliva E., García-Andrade I., Celemín D.... 49 Influence of Target Vessel, Conduit type and Graft Configuration in Mean Intraoperative Blood Flow of Aorto-Coronary Bypass Grafts González Santos J.M., González Rodríguez M., Arnáiz García M.E., Arévalo Abascal A., López Rodríguez F.J., Bueno Codoñer M., Dalmau Sorlí M.J.... 55 Miscellaneous Improvement of transcranial ultrasound uniformity by random modulation Saito O., Furuhata H.... 61 The Advantages of Using CBCT in Maxillofacial Imaging Chisăliţă G., Bîrsăşteanu F., Ciobanu G., Sferdian M.... 69 Biological and molecular characteristics, diagnosis and treatment of triple negative breast cancer Taushanova M., Timcheva K., Valev S., Aleksandrova E.... 73 Author Index... 79

ScienceMED, vol. 4, 1.2013, 1-8, Bologna (Italy) From Pulec s Cervical Tinnitus to Levine s Somatic Tinnitus Alpini D.C. 1, Cesarani A. 2, Hahn A. 3 1) ENT-Otoneurology Service Scientific. Institute S. Maria Nascente, Don Carlo Gnocchi Foundation, Milan,Italy tel. +39-2-40308-244 fax +39-2-40092297e-mail dalpini@dongnocchi.it 2) Dipartimento di Scienze Chirurgiche Specialistiche, Universita` degli Studi di Milano; Audiology Unit, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Milan, Italy 3) ENT Clinic, 3rd Medical Faculty, Charles University Prague, Prague,Czech Republic Abstract Somatic tinnitus is a sub-group of tinnitus suffers. It was described by Pulec et al.in 1978 as cervical tinnitus, considered as a consequence of degenerative changes in the cervical spine that could be, at least temporarly, reduced by injection of local anesthetic into tender areas of the neck. This clinical entity was forgotten until Levine et al. in 2007 introduced the Somatic Tinnitus Syndrome (STS)in which tinnitus is associated to a somatic disorder involving the head and neck. They presented the anatomical basis for the auditory-somatosensory interactions and showed how auditory neurons respond to somatosensory stimulation. Muscle--skeletal system could be a chronic stress source. In this way muscleskeletal disorders can pathologically integrate with auditory disturbances increasing tinnitus. In this way Stress Reaction Tinnitus (SRT) model could be implemented into Somatic Tinnitus Syndrome (STS) model and Tinnitus School can acts through fitted physiotherapy aimed to a patient-oriented treatment of selected tinnitus patients. Somatic Tinnitus, generally, is a well treatable condition by means of manipulations, physiotherapy and physical exercises, or at least, removal of somatic component of patient s tinnitus significantly decreases tinnitus annoyance and improves quality of life. Keywords: tinnitus, somatic tinnitus, cervical, tinnitus school Introduction Somatic tinnitus is a sub-group of tinnitus suffers. It was described by Pulec et al.in 1978 [1] as cervical tinnitus, considered as a consequence of degenerative changes in the cervical spine that could be, at least temporarly, reduced by injection of local anesthetic into tender areas of the neck. This clinical entity was forgotten 2013 by MEDIMOND Q419C0001 1

ScienceMED, vol. 4, 1.2013, 9-15, Bologna (Italy) Chronic Cerebrospinal Venous Insufficiency (CCSVI) IN Meniere Disease. Case or Cause? Alpini D.C.(1), Bavera P.M.(2), Hahn A.(3), Mattei V.(1) 1) Sc. Institute S. Maria Nascente, Don Carlo Gnocchi Foundation, via Capecelatro 66, 20148 Milan, Italy 2) Medick-Up Angiology Center via Monte Rosa 13 tel. +39024985581, Milan, Italy 3) ENT dept. III Medical Faculty, Prague (Czech Republik) Abstract CCSVI is the acronym for Chronic Cerebrospinal Venous Insufficiency, initially described by P.Zamboni, as being strongly associated with multiple sclerosis (MS). It is a syndrome characterized by stenosis of the internal jugular veins (IJVs) and/or azygous vein (AZ) with opening of collaterals and insufficient drainage. Bavera PM carried out 823 Duplex exams on a control group of 60 patients without MS. As expected CCSVI was found only in few subjects of the control group, three, two females and one male, but all affected with Sudden Sensorineural Hearing Loss (SSHL). Successively, we reported a case of bilateral SSHL with vertigo, showing evidence of the CCSVI pattern at Duplex examination (not associated with MS). To the best of the authors knowledge, this kind of association has never been reported. We studied 52 patients affected with cochleo-vestibular disturbances subdivided into two groups of out-patients:definite unilateral Meniere (Men): 12 subjects (8 males and 4.females, mean age 41,6.yy) according to international AOO-HNS 1995 diagnostic criteria - No-Meniere (No-Men): 14 subjects (6.males and 8 females, mean age 44,7.yy) affected with unilateral cocleo-vestibular impairment A third group of subjects have been considered, as a normal group, 13 patients (8 females and 5 males, mean age 45,5 yy) affected with Benign Paroxismal Positioning Vertigo (BPPV) with cochlear involvement Asymmetrical artherious flow in VA or CA was revealed in 2 Men 9 no-men and 1 BPPV, respectively 12,5-60,7 - and 8,6 %. Differences between Men and No- Men and between each of this group with respect to BPPV were highly significant (p<0.001). Asymmetrical venous flow in IJV or VV was detected in 9 patients in MEN group and in 4 in no-men and 2 BPPV, respectively 79-28,5 and 13 %. Differences between Men and No-Men and between each of this group with respect to BBV were highly significant (p<0.001) Key words: CCSVI, Meniere Disease, Vertigo, Hearing loss 2013 by MEDIMOND Q419C0003 9

ScienceMED, vol. 4, 1.2013, 17-19, Bologna (Italy) Diagnostic and rehabilitation of vestibular disorders with using of telemedicine tools Kelm M.(1), Dabrowska A.(1), Skarzynski P.H.(2,3,4), Skarzynski H.(3) 1. West Pomeranian Center of Hearing and Speech Medincus, Szczecin, Poland 2. Ophthalmic diagnostics and rehabilitation and sensory organs department, Medical University of Warsaw, Warsaw, Poland 3. Institute of Physiology and Pathology of Hearing, Warsaw, Poland 4. Institute of Sensory Organs, Kajetany, Poland Summary Vestibular disorders are more and more common. Numerous patients are subjected to surgery and after that a rehabilitation period can be carried out in an outpatient clinic. Centers of Hearing and Speech Medincus are connected via telemedical network with a higher reference center and offer telerehabilitation services. In the study we analyze results of patients with vestibular disorders and present their diagnostics and treatment. 300 patients were examined on August 2012 December 2012. We found 120 patients (40%) with BPPV, 99 (23%) unilateral labyrinth failure, 4 (1,3%) bilateral labyrinth failure. In the study different methods of rehabilitation and treatment were applied as well as confirmation from other specialist was included. Concluding, there is an urgent need to increase more specialized local diagnostic and rehabilitation centers. Application of special tools used in rehabilitation allow to obtain better results and patients satisfaction after treatment. Introduction Vertigo and dizziness are the frequent diagnostic and therapeutic problem that general practitioners such as laryngologists or neurologists have to deal with [1]. In some cases vertigo may occur in the postoperative period. Then a consultation, especially in cases of cochlear implantation should be performed [2]. Telemedical network connects 20 centers in Poland and 1 abroad in Odessa, Ukraine. In that centers we perform teleconsultations, telerehabilitation, telediagnostics and telefitting. The teleaudiology, including telefitting and telerehabilitation, is an innovative method that uses a system for remote rehabilitation and fitting of speech processors of cochlear implantees [2,3]. The telefitting and telerehabilitation are crucial for the patients after Partial Deafness Treatment and in aging population [4,5]. The equilibrium is an essential function and 2013 by MEDIMOND Q419C0023 17

ScienceMED, vol. 4, 1.2013, 21-23, Bologna (Italy) Vestibular aspects in cochlear implant procedure Skarzynski P.H.(1,2,3,4), Tacikowska G.(1,2), Skarzynski H.(1,2), Matusiak M.(1,2), Sosna M.(1,2), Pietrasik K.(1,2) 1. Institute of Physiology and Pathology of Hearing, Warsaw, Poland 2. World Hearing Center, Kajetany, Poland 3. Ophthalmic diagnostics and rehabilitation and sensory organs department, Medical University of Warsaw, Warsaw, Poland 4. Institute of Sensory Organs, Kajetany, Poland Summary Cochlear implantation procedures are nowadays accepted surgical procedures dedicated to patients with deafness. During recent years indications were extended and we can observe long-term results in patients after Partial Deafness Treatment (PDT). Aim of the study was to analyze possible vestibular complications that may occur during surgery and vestibular disorders among cochlear implanted patients. In a material of the Institute of Physiology and Pathology of Hearing there is 3994 cochlear implant patients. Vestibular failures and surgical complications are not common in centers that perform large number of otosurgeries including numerous cochlear implantations per year. Vestibular problems may be mainly caused by either insertion of the electrode to semicircular canals or mechanical motional abnormality of the ossicles. Vestibular system assessment, applying a battery of tests dedicated to cochlear implantees, is recommended. Introduction The first cochlear implantation in Poland was performed in 1992 [1]. Assessment procedure always is focused on hearing tests and possibilities of stimulation of the cochlear part of the n. VIII with an electrode. During last years of previous century and beginning of the new century some centers have begun to add acoustic stimulation to cochlear implants. The first classification of patients selected to that procedure was announced in 2009 during 10 th European Symposium of Cochlear Implantation (Fig. 1) [2,3]. Depending on a hospital we can observe increase of number of studies based on Head Impulse Test (HIT) or Vestibular Evoked Myogenic Potentials (VEMP) [4,5,6]. In cases of similar hearing and anatomical conditions vestibular evaluation could be 2013 by MEDIMOND Q419C0028 21

ScienceMED, vol. 4, 1.2013, 25-27, Bologna (Italy) Mechanical bridging to recovery after heart transplantation Schmid C. Dept. of Cardiothoracic Surgery, University Medical Center, Regensburg, Germany Heart transplantation is becoming increasingly difficult, mainly due to a tremendous donor shortage. As a consequence, much more borderline donor organs are accepted, and the risk allograft dysfunction rises. Eventually, patients suffer primary graft failure with low cardiac output, hypotension, and increased filling pressures. During the first 30 days after surgery, primary graft failure is the most frequent cause of death according to the ISHLT data (www.ishlt.org). The reasons for primary graft failure include long ischemic time with inadequate organ preservation, use of marginal donor organs, old age, high-dose inotropic support, size mismatch and pulmonary hypertension. Early death rates are high, and long-term survival is clearly inferior. Treatment strategies of primary graft failure consist of inotropic drug therapy including levosimendan, mechanical support, and retransplantation. As drug therapy usually fails and retransplantation is nearly impossible (in most countries) and also yields unfavorable results, various kinds of mechanical support represent the therapy of choice. If the clinical situation seems to be borderline with a moderately impaired global pump function, the placement of an intra-aortic balloon pump (IABP) can be considered. There is hardly any contra-indication apart from severe peripheral occlusive arterial disease. However, the effectiveness with regard to the cardiocirculatory stabilization is limited and a recent study, where the IABP was tested in shock situations after myocardial infarction showed no benefit. Sufficient short-term mechanical support can be provided with the implantation of ventricular assist systems (VAD) and extracorporeal membrane oxygenation (ECMO). In case of global heart failure, biventricular support is necessary, which can be provided with several devices. The Abiomed BVS 5000 is a bed-side full automated system which was largely used in the past, but is now no longer available. The idea of the company for a bed-side transition to a left-ventricular or biventricular VAD was not accepted by the community for various reasons. Instead, paracorporeal pneumatic VADs such as the Thoratec PVAD or the BerlinHeart Excor remained the standard, supplemented by the CardioWest total artifical heart. More recently and with the exchange of old-fashioned roller pumps with modern centrifugal pumps, extracorporeal solutions with Rotaflow (Maquet) or the CentriMag (Levitronix) pumps 2013 by MEDIMOND Q620R9019 25

ScienceMED, vol. 4, 1.2013, 29-34, Bologna (Italy) Replacement of Ascending Aorta with Bentall DeBono Technique Vargas R. 1, Perez R. 1, Yeger A. 1, Cuesto I. 1, Cabo J. 2 Department of Cardiovascular Surgery. Fundación-Clínica Corazones Unidos Santo Domingo, Dominican Republic 1 Author Affiliation, (Dominican Republic) 2 Author Affiliation, (Spain) e-mail: arvort@gmail.com Abstract This is a retrospective observation study after identification of all patient cohorts who underwent aorta replacement in patients with Acute Aortic Dissection (AAD) in our Institution since May 1994 to November 2008. The population was predominantly male (16=84.2%) and three female (15.78%), mean of age 50.2 years and hypertension was the most significant factor. The operating procedures were Bentall De Bono and St. Jude and Carbomedic composite valve replacement grafts (CVGR), used indistinctively. Hospital mortality rate was 15.78% (three patients), the freedom from reoperation at 15 years was 89.48% and three patients died during the follow-up period, 68.4% long-term survival. Our results confirm that Bental De bono procedure is still an excellent choice for AAD. Keywords: AAD, Bentall DeBono procedure. History The first described aortic aneurysm is found in Ebers Papyrus (1552 BC), discovered by Ewin Smith in Luxor 1862. Each Galen (II Century AD) and Vesalius (XVI Century) had given some information about arterial dissection, but was Sennertus who, in 1650, made the first description of the dissection aortic process. A century later, in 1761 Morgagni described a case of broken aortic dissection (referring to the case of King George II of England) based on the findings of the autopsy that Nicholls conducted a year before, which corresponded to what now is known as aortic dissection, a name which, in turn, was given by Maunoir in 1802. The first reports on aortic root repair were made by Hufnagel (1962) and Morris (1963); in same year, Starr reported an ascending aorta replacement plus a mechanic prosthesis in the aortic position. Five years later, Bentall and Bonno reported (1968) the total replacement of the aortic root with a valve conduit (composite root replacement). 2013 by MEDIMOND Q620R9027 29

ScienceMED, vol. 4, 1.2013, 35-41, Bologna (Italy) Intramyocardial Implantation of Stem Cells in Combination with CABG in AMI with Severe Ventricular Dysfunction. First Cases in Dominican Republic Vargas R. 1, Benzo M. 1, Grullón E. 1, Cabo J. 2 Department of Cardiovascular Surgery. Fundación-Clínica Corazones Unidos Santo Domingo, Dominican Republic 1 Author Affiliation, (Dominican Republic) 2 Author Affiliation, (Spain) e-mail: arvort@gmail.com Abstract Objetive: To demonstrate the feasibility of stem cells (SC) implant into the myocardium associated with coronary artery bypass grafting (CABG) in our country, also to demonstrate the effectiveness of SC in cases of myocardial infarction with severe ventricular malfunction. Methods: An aorto-coronary bypass surgery plus intramyocardial bone marrow stem cells implant was performed in two males with severe ventricular malfunction post-infarction. There were no intraoperative and postoperative complications. During a follow-up period of 65 to 84 months, we have no morbid events at all and an unquestionable improvement of patients clinical condition. The post surgery Sestamibi tests reveal a clear increase of myocardial perfusion with regards to prior surgery tests, demonstrating adequate cardiac muscle regeneration. We conclude that our results reproduce the findings described in the literature as evidence of cardiac muscle regeneration. Keywords: stem cells, CABG, myocardial infarction, severe ventricular malfunction, Sestamibi, muscle regeneration. Introduction Since the Russian histologist Alexander Maxímov proposed the term Stem Cells (SC) for hematopoietic cells in 1908 at the Congress of Hematologic Society in Berlin to define the existence of these cells, many things have occurred from then, so a new 2013 by MEDIMOND Q620R9028 35

ScienceMED, vol. 4, 1.2013, 43-48, Bologna (Italy) Clinical and echocardiographic results with a new three-dimensional tricuspid ring Arévalo Abascal A., González Santos J.M., Arnáiz García E., López Rodríguez J., Bueno Codoñer M., Dalmau Sorlí M.J. Cardiac Surgery Department. University Hospital of Salamanca, Spain. Abstract Introduction: We present our initial experience with the new three-dimensional ring Carpentier-Edwards-Physio-Tricuspid,(CEPhT). Methods: We used this ring in 64 patients. The indications for tricuspid annuloplasty (TA) were the presence of a severe tricuspid regurgitation (TR) (39%) or a slight or moderate TR associated with significant annular dilatation (61%). The expected mortality estimated with EuroScore I and II was 10.05% and 6.23% respectively. Results: The immediate postoperative mortality was 4.6%. The ring implant was technically simple and there were no perioperative complications. Survival at 16 months was 90.6%. The echocardiographic study showed freedom from recurrent moderate-severe TR in 92% of patients. Conclusions: The new three-dimensional tricuspid ring corrects TR effectively and provides good short-term clinical and echocardiographic results. Introduction Functional tricuspid regurgitation (TR) is common in patients with left valvular pathologies. The most common mechanism of TR is type I Carpentier s functional classification (anular dilatation) (1). The dilatation of the tricuspid annulus does not affect its four segments to the same degree. Annular dilatation affects mainly in anterior/posterior segment. This functional TR is most of the time amenable to surgical reconstructive techniques (suture or prosthetic annuloplasty). Tricuspid annuloplasty (TA) with a ring is the most widespread repair technique due to its high efficiency. Several clinical series have shown the superiority of prosthetic remodeling annuloplasty over other surgical techniques (1, 2-4). We present our initial experience with the new three-dimensional ring Carpentier- Edwards Physio Tricuspid (CEPhT) in patients with significant functional TR who underwent tricuspid valve repair with this prosthesis in combination with left-sided 2013 by MEDIMOND Q620C0032 43

ScienceMED, vol. 4, 1.2013, 49-54, Bologna (Italy) Preoperative Levosimendan Treatment in High Risk Surgical Patients with Ischemic Mitral Disease Ferreiro A.¹, Garrido J.M.¹, Muñoz R.¹, Gajate L.², Boi S.¹, Martín M.¹, Prada P.¹, Redondo A.¹, Miguelena J.¹, Oliva E.¹, García-Andrade I.¹, Celemín D.¹ ¹ Departament of Cardiac Surgery, Hospital Universitario Ramón y Cajal, (Spain) ² Departament of Anesthesiology, Hospital Universitario Ramón y Cajal, (Spain) e-mail: andrea.ferreiro.m@gmail.com Abstract Objetive: Patients with chronic ischemic mitral regurgitation (IMR) have a poor prognosis, especially in those with severe left ventricular dysfunction. The present communication shows the positive effects of preoperative tratment with Levosimendan in patients with severe IMR and LVEF < 30% scheduled for CABG and mitral valve repair, even in patients without heart failure symptoms. Methods: We present two patients with severe mitral regurgitation, severe left ventricle systolic dysfunction (LVEF < 30%) and coronary artery disease scheduled for CABG and mitral valve repair, included in a study with preoperative Levosimendan therapy. Levosimendan is an inodilator agent used in short-term treatment of heart failure, improving myocardial contactility and produces systemic arterial/venous, pulmonary and coronary arteries vasodilation.we use the Levosimendan infusion during 12 hours prior to surgery (0.1 mcg/kg/min without receiving the loading dose. Results: Case 1: 73-years-old man with three vessels disease, severe IMR, LVEF: 29.7% and severe chronic pulmonary disease (Euroscore: 11). After pre-aconditioning with Levosimendan we realized two bypasses (LIMA-AD, SV-OM(CX), non-practicable RC) and mitral valve repair, undersizing with the prosthetic ring Etlogix nº 28 and suturing the scallop between P2 and P3 using a 5/0 prolene suture. Clamp time: 98 min. CBP time: 120 min. Postoperative Echo: minimal MR with LVEF 47,3%. The patient was 10 days in ICU, and hospital discharge was 7 days after. Case 2: 80-years-old man with three vessels disease, severe IMR, LEVF: 25% and severe chronic pulmonary disease (Euroscore: 15). After pre-aconditioning with Levosimendan we realized two bypasses (LIMA-AD, SV-PD(RC), non-practicable CX) and mitral valve repair, undersizing with the prosthetic ring Etlogix nº 28. Clamp time: 112 min. CBP 120 min. Postoperative Echo: minimal MR with LEVF: 45,2%. The patient was 4 days in ICU, and hospital discharge was 2013 by MEDIMOND Q620C0036 49

ScienceMED, vol. 4, 1.2013, 55-59, Bologna (Italy) Influence of Target Vessel, Conduit type and Graft Configuration in Mean Intraoperative Blood Flow of Aorto-Coronary Bypass Grafts González Santos J.M. 1, González Rodríguez M. 2, Arnáiz García M.E. 1, Arévalo Abascal A. 1, López Rodríguez F.J. 1, Bueno Codoñer M. 1, Dalmau Sorlí M.J. 1 1 Cardiac Surgery Department. Hospital Universitario de Salamanca, Salamanca (Spain) 2 Anesthesiology Department, Hospital Universitario Central de Asturias. Oviedo (Spain). e-mail: jmgs@usal.es Abstract Intraoperative aorto-coronary graft flow magnitude reflects the quality of myocardial revascularization. It is associated with graft patency and clinical outcome. However, there is little information relative to normal flow values concerning to target vessel, conduit type and graft configuration. We recorded the mean flow (MF) in ml/min of 1891 aorto-coronary grafts performed in 729 patients. Conduits used consisted of: major saphenous vein (SV) in 1034 cases, left internal mammary artery (LIMA) in 634, right internal mammary artery (RIMA) in 140 and radial artery (RA) in 83. There were 1583 simple and 308 sequential grafts. Flow was measured at the end of the intervention using a transittime method based flowmeter (Butterfly, MediStim). The average MF was 34.8±9 ml/min. MF was significantly higher for sequential than for simple bypass grafts, both in the global analysis (44.4 vs. 32.9, p < 0.0001) as in each target vessel. The MF of simple grafts was higher in RIMA grafts (36 ml/min) and in those destined to obtuse marginal (OM) branches and right coronary artery (31 ml/min). MF of sequential grafts was also higher in those anastomosed to OM branches (47 ml/min) and in those performed with SV (44 ml/min). Intraoperative graft flow depends on the target vessel, the type of conduit and its configuration. In simple bypass grafts, higher MF was found in squeletonized RIMA grafts anastomosed to the OM. Concerning sequential grafts, a significantly higher MF was detected in those constructed with SV and destined to the OM. Keywords: Coronary surgery, aorto-coronary-grafts, flow measurement 2013 by MEDIMOND Q620C0040 55

ScienceMED, vol. 4, 1.2013, 61-68, Bologna (Italy) Improvement of transcranial ultrasound uniformity by random modulation Saito O. 1, Furuhata H. 1 1 Medical engineering laboratory, Research center for medical science, The jikei university school of medicine, (Japan) - e-mail:osaito@jikei.ac.jp Abstract It is known that transcranial ultrasound irradiation can enhance the effect of thrombolytic agent tissue plasminogen activator (tpa) depending on the intensity. Because of the interference properties of ultrasounds, the ultrasound beam is inhomogeneous in the near-field region of the transducer i.e. there are low-intensity (cold) spots of the ultrasound and high-intensity (hot) spots. The inhomogeneous distribution can be problematic for sonothrombolysis, because the effect of the tpa cannot be enhanced at the cold spots and the risk of haemorrhage is higher at the hot spots. In this work, we showed that the cold and hot spots problem can be resolved by random modulation of the activating signal, which was first introduced in order to reduce the standing waves in the skull. In particular, we investigated the random modulation method which inverts the phase of the sinusoidal wave at random timing. We compared the random modulation method with sinusoidal one. In order to quantify the uniformity of the ultrasound field, we used Uniformity Index (UI), which was defined by authors. By the definition, it is inferred that the smaller value of UI means the more homogeneous field. We calculated the UI from the field distribution obtained by hydrophone measurement. While the UI was 306 for sinusoidal wave in the freefield (without any obstacle) case, it was 213 for randomly modulated wave. In the case of passing through the temporal bone fragment, the UI was 566 for sinusoidal wave and 266 for randomly modulated wave. It was shown that random modulation method can resolve cold and hotspots problem as well as standing wave problem. The present study is expected to be useful for the development of safer and effective transcranial therapeutic equipment. Keywords: Sonothrombolysis, random modulation, uniformity. Introduction Recently it has been clinically shown that transcranial ultrasound irradiation helps 2013 by MEDIMOND Q526C0085 61

ScienceMED, vol. 4, 1.2013, 69-71, Bologna (Italy) The Advantages of Using CBCT in Maxillofacial Imaging Chisăliţă G. 1, Bîrsăşteanu F. 2, Ciobanu G. 3, Sferdian M. 3 1 Vasile Goldiş Western University Arad, Faculty of Medicine, Pharmacy and Dentistry, Romania 2 Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania 3 Vasile Goldiş Western University Arad, Faculty of Medicine, Pharmacy and Dentistry, Romania Summary In this article we evaluate the main advantages and disadvantages of the CBCT (cone beam computed tomography) in maxillofacial imaging. The study was conducted on over 1000 patients that were investigated through x-ray, panoramic radiographs and CBCT over 5 years. The main pathology was represented by cysts, traumatisms, benign and malign tumors. We also evaluated the dental implants through CBCT. The conclusion was that CBCT is cost effective; the radiation dose was almost similar to that of a panoramic view. In dental implants treatment it provides very useful measurement details (both 2D and 3D). Introduction During the last years the imaging modalities used in investigating the maxillofacial region such as digital imaging, computed tomography, magnetic resonance imaging, positron emission tomography and cone beam computed tomography) are developing very fast. They provide high quality new images that continually contribute to the improvement of the diagnostic tasks. Materials and Method The study was conducted on over 1000 patients from VIVAS DENT clinic from Arad, Romania, over a period of 5 years. The patients were investigated through retro-alveolar radiographs, panoramic radiograph and cone beam computer tomography (CBCT - using a KODAK 9000 3D System). After the clinical investigation we performed a panoramic view. If it was suspected 2013 by MEDIMOND 69

ScienceMED, vol. 4, 1.2013, 73-78, Bologna (Italy) Biological and molecular characteristics, diagnosis and treatment of triple negative breast cancer Taushanova M. 1, Timcheva K. 1, Valev S. 1, Aleksandrova E. 2 1 Clinic of Medical oncology of spetialized hospital for active treatment in oncology - Sofia, Bulgaria 2 Clinic of thoracic surgery of spetialized hospital for active treatment in oncology - Sofia, Bulgaria Abstract Carcinoma of the mammary gland is an issue of social importance. Frequency is constantly rising, imposing in-depth study. By applying immune-histochemical and genetic research, it has helped introduce several molecular subtypes of breast cancer. One is triple negative cancer / TNC / with ER, PR, HER2 negative status. It features an extremely heterogeneity in terms of their molecular and genetic characteristic.tnc occurs with more aggressive than other breast cancer subtypes and manifests with early recurrence, frequent visceral metastases, shorter overall survival. These features have led to its detailed study. In this context, TNCs are divided into several subtypes with specific immune-histochemical and genetic characteristics. Discovering of new molecular markers, gives light in the study of TNCs. This is related to the prognosis of the disease, the way and the type of therapy. Discoveries at genetic and molecular level of TNCs are related to the introduction of new target therapy, which will lead to better results in the treatment of this aggressive type of breast gland. All this is a step forward in the implementation of individualized therapy for TNC. Key words: triple-negativnen cancer, molecular subtypes, molecular markers, genetic testing, immunohistochemical examination, treatment, therapy target Introduction The incidence of breast cancer in the last 25 years has increased by 30%. 1.4 million new cases have been registered annually. In Bulgaria frequency of breast cancer is 22.8%. Triple negative cancer, characterized by ER, PR and HER2 negative status is about 15-20% of newly diagnosed cases of breast cancer. 2013 by MEDIMOND P705C2100 73

Author Index Aleksandrova E., 73 Alpini D.C., 1, 9 Arévalo Abascal A., 43, 55 Arnáiz García E., 43 Arnáiz García M.E., 55 Bavera P.M., 9 Benzo M., 35 Bîrsăşteanu F., 69 Boi S., 49 Bueno Codoñer M., 43, 55 Cabo J., 29, 35 Celemín D., 49 Cesarani A., 1 Chisăliţă G., 69 Ciobanu G., 69 Cuesto I., 29 Dabrowska A., 17 Dalmau Sorlí M.J., 43, 55 Ferreiro A., 49 Furuhata H., 61 Gajate L., 49 García-Andrade I., 49 Garrido J.M., 49 González Rodríguez M., 55 González Santos J.M., 43, 55 Grullón E., 35 Hahn A., 1, 9 López Rodríguez F.J., 55 López Rodríguez J., 43 Martín M., 49 Mattei V., 9 Matusiak M., 21 Miguelena J., 49 Muñoz R., 49 Oliva E., 49 Perez R., 29 Pietrasik K., 21 Prada P., 49 Redondo A., 49 Saito O., 61 Schmid C., 25 Sferdian M., 69 Skarzynski H., 17, 21 Skarzynski P.H., 17, 21 Sosna M., 21 Tacikowska G., 21 Taushanova M., 73 Timcheva K., 73 Valev S., 73 Vargas R., 29, 35 Yeger A., 29 Kelm M., 17 2013 by MEDIMOND s.r.l. 79